术前确定高危手术患者的患者报告问卷。

IF 2.1 3区 医学 Q2 SURGERY
Renske Meijer, David W G Ten Cate, Bart C Bongers, Marta Regis, Hans H C M Savelberg, Gerrit D Slooter, Stef Janssen, Martijn van Hooff, Goof Schep
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引用次数: 0

摘要

目的:低心肺适能(CRF)增加大手术术后发病率和死亡率的风险。术前通过测量心肺运动试验(CPET)期间的峰值摄氧量(vo2峰值)来评估CRF是有价值的,但尚未广泛应用。本研究旨在评估问卷是否可以用于术前识别高危手术患者。方法:健康参与者和接受CPET的患者完成FitMáx、Duke活动状态指数(DASI)、改进的4题DASI (M-DASI-4Q)、退伍军人特定活动问卷(VSAQ)和任务代谢当量(MET)问卷。将问卷- vo2峰与cpet - vo2峰进行比较。采用受试者工作特征曲线下面积(AUC)评价问卷的整体效能。此外,根据约登指数或预先指定的水平,确定敏感性、特异性和预测值。结果:共纳入361名受试者。所有问卷均显示高AUC值,以cpet - vo2峰值阈值确定高危患者。FitMáx和VSAQ的结果优于其他问卷。根据约登指数,FitMáx的最佳问卷vo2峰截断值分别为20.6、21.3和26.1 ml·kg-1·min-1, vo2峰阈值分别为16.0、18.2和24.5 ml·kg-1·min-1对应的VSAQ分别为16.3、18.2和20.4 ml·kg-1·min-1。结论:FitMáx和VSAQ能够在术前识别手术高危患者(由cpet - vo2峰值阈值定义),可以用于识别手术高危患者。对于FitMáx和VSAQ预测vo2峰值分别≤21.3和≤18.2 ml·kg-1·min-1的患者,应进行正式的术前(心肺)运动试验。试验注册:该研究在荷兰医学研究综述中注册为NL-OMON23304,追溯至2020年4月28日。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Patient-reported questionnaires to preoperatively identify high-risk surgical patients.

Purpose: Low cardiorespiratory fitness (CRF) increases the risk of postoperative morbidity and mortality following major surgery. Assessing CRF preoperatively, by measuring peak oxygen uptake (VO2peak) during cardiopulmonary exercise testing (CPET), is valuable yet not widely available. This study aimed to assess whether questionnaires could be used preoperatively to identify high-risk surgical patients.

Methods: Healthy participants and patients who underwent CPET completed the FitMáx, Duke Activity Status Index (DASI), the modified 4-questions DASI (M-DASI-4Q), Veterans-Specific Activity Questionnaire (VSAQ), and Metabolic Equivalents of Task (MET) questionnaire. Questionnaire-VO2peak was compared with CPET-VO2peak. Overall performance of the questionnaires was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. Furthermore, corresponding to the Youden index or pre-specified levels, sensitivity, specificity, and predictive values were determined.

Results: In total, 361 participants were included. All questionnaires showed high AUC values to identify high-risk patients, defined on the basis of CPET-VO2peak thresholds. FitMáx and VSAQ demonstrated superior results compared to the other questionnaires. Based on the Youden index, the optimal questionnaire-VO2peak cut-off values were 20.6, 21.3, and 26.1 ml·kg-1·min-1 for the FitMáx and 16.3, 18.2, and 20.4 ml·kg-1·min-1 for the VSAQ corresponding to the VO2peak thresholds 16.0, 18.2 and 24.5 ml·kg-1·min-1 respectively.

Conclusion: The ability to identify high-risk surgical patients preoperatively (defined by the CPET-VO2peak thresholds) by the FitMáx and the VSAQ indicates that they could be used to identify high-risk surgical patients. Patients with a poor predicted VO2peak ≤ 21.3 and ≤ 18.2 ml·kg-1·min-1, respectively for FitMáx and VSAQ, should be referred to formal preoperative (cardiopulmonary) exercise testing.

Trial registration: The study was registered as NL-OMON23304 in the Overview of Medical Research in the Netherlands, retrospectively at 28-04-2020.

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来源期刊
CiteScore
3.30
自引率
8.70%
发文量
342
审稿时长
4-8 weeks
期刊介绍: Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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